pollutants, as nutrition can have a buffering or synergistic effect on PM-induced cardiovascular
responses and effects on the fetus.
5.5 Conclusions
There is clear evidence that, with a few exceptions, poorer people tend to live in lower-quality
environments and are more exposed to air pollution. This inequality is not necessarily an injustice,
provided that the levels of exposure are not hazardous and that deprivation does not increase
vulnerability; however, neither of these conditions seems to apply.
While many aspects of air quality have improved over the past few decades, there are still breaches of air
quality standards, particularly in urban areas, and some important air pollutants are 'non-threshold
toxins', meaning that any level of exposure will have an impact at a population level. Deprivation seems
particularly linked with increasing susceptibility to PM exposure and cardiorespiratory effects, although
the precise mechanisms remain unclear. There is a general pattern that deprived populations, although
not always more exposed, experience greater harmful effects of air pollution because of vulnerability
factors. There is also some research suggesting that obesity may negatively modify risk and that exposure
to some chemicals may be implicated in the development of metabolic syndrome. It is also clear that
poorer people have other health, social and environmental stressors, such as poor-quality housing, higher
0
100
England and Wales
Routine
Semi-routine
Lower supervisory and technical
Small employers, own account workers
Intermediate
Lower managerial, professional
Higher managerial, professional
E SW SE EM
Region
Mortality
rate
per
100,000
WM YH L NW NE
200
300
400
500
600
700
800
Fig 18. Age-standardised mortality rates by socio-economic classification and region, for men aged 25–64
years, 2001–2003.
14
Data originally from Office for National Statistics (2008): ww.ons.gov.uk/ons/rel/hsq/
health-statistics-quarterly/no—40—winter-2008/regional-differences-in-male-mortality-inequalities-using-
the-national-statistics-socio-economic-classification—england-and-wales—2001-03.pdf.
© Royal College of Physicians 2016 75
5 Our vulnerable groups
